Radiofrequency ablation of liver metastasis from breast cancer

As the hepatic metastasis from breast cancer has a tendency to have an extrahepatic lesion, systemic therapy therefore becomes acclimatization. However, local therapy is regarded as one of the choices if there is no extrahepatic lesion. We present three cases of liver metastasis from the breast treated by radiofrequency ablation (RFA). Case 1: A 65-year-old woman was treated by left mastectomy in 1997. Radiation exposure was performed for lung metastasis, and a weekly paclitaxel therapy was administered in 2001. We performed RFA percutaneously for liver metastasis of 2.8 cm in 2002. The aggravation spread to the lung lesion and she died after RFA within one year. The liver metastasis finally enlarged to 4 cm in size. Case 2: A 36-year-old woman was treated by left mastectomy (Stage IIIa), and was followed by chemotherapy in 2000. We performed RFA for metastasis of 2 cm of liver (S7) percutaneously in 2001, and didn't recognize a recurrence to date for 3 years and 8 months. Case 3: A 43-year-old woman was treated by left mastectomy (Stage IIIa), and followed by chemotherapy in 2003. We performed RFA for a liver metastasis of 3.5 x 4 cm under laparotomy in 2004. She has been disease free for 15 months.     

Effective combination chemotherapy using weekly trastuzumab and paclitaxel in the treatment of a recurrent breast cancer patient with liver metastases

A 48-year-old woman was diagnosed with multiple locoregional recurrence five months after receiving breast conserving surgery, and she underwent mastectomy. CEF therapy was combined following surgery; however, lung metastases developed 9 months after the initial surgery. A CR has been observed after monthly use of docetaxel alone for 14 months. Since multiple liver metastases were detected 17 months later, the patient was given monthly docetaxel infusions for 2 months followed by weekly trastuzumab infusions for 8 weeks, resulting in PD. Thereafter, combination of weekly trastuzumab with paclitaxel was used and a nearly CR remained for 10 months. Although multiple brain metastases were seen 36 months later, vertigo was mostly controlled with whole brain radiotherapy. Combination of weekly trastuzumab and paclitaxel therapy is effective for liver metastases from breast cancer and useful considering the slight side effects and possibility of long-term administration.     

A case of paclitaxel and trastuzumab-resistant recurrent breast cancer with liver metastasis responding to S-1

We experienced a case of paclitaxel- and trastuzumab-resistant recurrent breast cancer with liver metastases showing significant improvement by S-1. A 76-year-old woman was diagnosed with left breast cancer(T2N1M0, Stage II B). She received total mastectomy and CEF(cyclophosphamide 500 mg/m(2), epirubicin 60 mg/m(2), 5-FU 750 mg/m(2))as adjuvant chemotherapy in March 2004. But twelve months later, she was referred to our clinic for management of lung and left supraclavicular lymphnode metastases. Then weekly paclitaxel(80 mg/m(2))and trastuzumab were started. After 2 cycles of weekly paclitaxel and trastuzumab treatment, lung and lymphnode metastases were reduced and the patient showed a clinical response(CR), so she was treated by trastuzumab only. But seven months later, she was diagnosed as a recurrence of liver metastases. She was treated by combined paclitaxel and trastuzumab again, but liver metastases and tumor marker were progressive. S-1 was administered orally 100 mg/day every day for 4 weeks, followed by a 2-week rest interval as 1 cycle, and trastuzumab was injected at 2 mg/kg/week for every weeks. After 2 courses of the treatment, the level of tumor marker and tumor size of liver metastases were reduced. Only rash(grade 1)was observed during treatment. The treatment of S-1 is thought to be effective for taxane-resistant recurrent breast cancer.     

Two patients of recurrent breast cancer with carcinomatous pleurisy well controlled pleural effusion

We report two patients of recurrent breast cancer with carcinomatous pleurisy well controlled pleural effusion. One patient is a 49-year-old woman. She underwent radical mastectomy for right breast cancer in September 1993. She suffered from multiple liver metastases in June 2000, so CEF therapy contained hepatic arterial infusion chemotherapy and extended right lobectomy of the liver were performed in December 2001. Right pleural effusion was detected in December 2003, then, pleurodesis was carried out with OK-432 after thoracic drainage. After pleurodesis, a weekly paclitaxel therapy was started and she was taking the regimen continuously. Another patient is a 55-year-old woman. She underwent radical mastectomy for left breast cancer in September 1999. Local recurrent lesions on the left chest and left pleural effusion were found in May 2003. After thoracic drainage, infectious pleurisy was complicated, so the drainage tube was removed after the therapy for preventing infection. After pleurodesis, CE therapy followed by peroral chemo-endocrine therapy was performed. Both of the two patients are receiving outpatient treatment without recurrent pleural effusion as of July 2005.     

Two patients having recurrent breast cancer with brain metastases well controlled with a gamma knife radio-surgery

We report two patients having recurrent breast cancer with brain metastases that was controlled well with a gamma knife radio-surgery. The patient is a 50-year-old woman. She underwent radical mastectomy for right breast cancer in September 1993. She suffered from multiple liver metastases in June 2000, so CEF therapy contained hepatic arterial infusion chemotherapy, and extended right lobectomy of the liver were performed in December 2001. Afterward, pleurodesis was carried out to the carcinomatous pleurisy. Then she underwent simple total hysterectomy and bilateral oophorectomy for torsion of the metastatic ovarian tumor. MRI study revealed brain metastases with a diameter of 1 cm in her right midbrain in April 2005, so a gamma knife radio-surgery was performed. After the radio-surgery, a weekly paclitaxel therapy followed by peroral chemotherapy with capecitabine was started, and she took the regimen continuously. Another patient is a 56-year-old woman. She underwent skin sparing mastectomy with axillary lymph node dissection for right breast cancer in November 2002. Metastases to the base of her skull were found in October 2004, so a gamma knife radio-surgery was carried out. After the radio-surgery, a weekly paclitaxel therapy with anastrozole was started. In both of the two patients, the metastatic brain tumors have not shown growth so far and are under good control as of March 2006.     

A case of recurrent breast cancer with bone marrow metastasis treated with weekly paclitaxel therapy

A 44-year-old woman with bone marrow metastasis from breast cancer was treated with weekly paclitaxel therapy. She underwent radical mastectomy for right breast cancer (T2N1M0, Stage II B) in April 2003, and was then treated with hormonal therapy (leuprorelin). In November 2005, she received radiation for bone metastasis in thoracic and lumbar vertebrae, and bisphosphonate therapy was performed. Additional hormonal therapy (tamoxifen) was administered for progressive bone metastasis. However, in September 2006, pancytopenia was recognized and bone marrow metastasis was diagnosed by bone biopsy. Disseminated intravascular coagulation (DIC) developed, so she was given weekly paclitaxel therapy with blood transfusion and G-CSF injection. Improvement of pancytopenia and tumor markers was recognized temporarily, and but 3 months later the tumor markers increased again. Four months after introduction of chemotherapy, she died of gastrointestinal hemorrhage.     

A case of recurrent breast cancer with multiple lung, adrenal, inferior vena cava tumor thrombus and bone metastases successfully treated with 5'-DFUR and hormonal therapy

A 42-year-old woman with multiple organ metastases from breast cancer was successfully treated with 5'-deoxy-5-fluorouridine (5'-DFUR) and hormonal therapy (leuprorelin+tamoxifen). She underwent radical mastectomy for advanced left breast cancer in June 1998. In September 2000, she was treated with docetaxel for multiple lung metastases, and the lesions were diagnosed as in complete remission. In June 2001, she received radiation for bone metastasis in left femoral and received a resection of subcutaneous metastases in the face. Then she received 2 courses of paclitaxel. In May 2002, she had multiple lung metastases, right adrenal metastasis, tumor thrombus in the inferior vena cava and multiple bone metastases, and was treated with cycrophosphamide, epirubicin, and 5-FU, however, they were abandoned due to severe leucopenia. Therefore, 600 mg/day of 5'-DFUR was administered from December 2002. The lesions of lung and adrenal decreased extendedly in March 2003. She was diagnosed as being in CR in March 2004, and this condition has continued to the present.     

Markedly effective regimen using bi-weekly trastuzumab and paclitaxel in an advanced breast cancer with multiple liver metastases

A 69-year-old woman had a 7 x 6 cm tumor on her left breast with ipsilateral axillary lymph node swelling and multiple liver metastases as detected on CT scan (T 3 N 2 M 1 b, Stage IV). Core needle biopsy and immunohistochemistry of breast tumor showed invasive ductal carcinoma with negative hormone receptor and overexpression of HER 2. After a treatment failure of 3 months weekly trastuzumab monotherapy, a combination of bi-weekly trastuzumab and paclitaxel (weekly 6, bi-weekly 9 courses), was given. Tumor markers became negative 4 months later, and multiple liver nodules, breast tumor and axillary nodes completely disappeared 9 months later. Breast surgery was avoided, and CR was maintained more than 8 months only with bi-weekly trastuzumab. From the standpoint of the patient's convenience,a bi-weekly schedule of trastuzumab and paclitaxel could be a promising treatment choice for metastatic breast cancer.     

Two cases of HER2-positive advanced or metastatic breast cancer, responding to lapatinib and capecitabine

The first patient was a 59-year-old woman who was diagnosed with invasive scirrhous carcinoma. The tumor was estrogen receptor (ER)-positive, progesterone receptor (PgR)-positive, and human epidermal growth factor receptor 2 (HER2)-positive. The patient was treated with adjuvant chemotherapy and endocrine therapy after surgery. Liver metastases developed 5 years after surgery. She was treated with trastuzumab combined with vinorelbine, paclitaxel, or docetaxel. The liver metastases increased in size, 9 years after surgery, and she was treated with lapatinib and capecitabine. The efficacy of chemotherapy was judged as a partial response. The second patient was a 74-year-old woman who was diagnosed with invasive ductal carcinoma in 2005. The tumor was ER-negative, PgR-positive, and HER2-positive; she was treated with trastuzumab and paclitaxel. She developed dyspnea in January 2010. Chest radiograph showed increased lung metastases and left pleural effusion; she was treated with lapatinib and capecitabine. Lung metastases decreased and left pleural effusion disappeared after the first cycle of chemotherapy. The efficacy of chemotherapy was judged as a partial response.     

A case of breast cancer liver metastases responding to lapatinib and capecitabine therapy

We report a 55-year-old female with liver metastases from breast cancer who responded to lapatinib and capecitabine combination therapy as third-line. She was diagnosed as invasive ductal carcinoma (T1cN1M0, stage IIA). Biomarker of breast cancer was negative hormone receptor (ER-, PgR-) and overexpression of HER2(HercepTest 3+). We started preoperative chemotherapy with weekly paclitaxel followed by FEC100. Then mastectomy with axillary dissection was performed. Histopathology of the breast and lymph nodes showed complete disappear of invasive cancer cells( pCR, grade 3). We performed her adjuvant therapy with trastuzumab after surgery. The liver metastases developed 5 months after surgery. We treated her in trasutumab combined with vinorelbine, and followed by docetaxel during one year and four months. Because liver metastases re-grew during the combination therapy with trastuzumab, we switched to lapatinib and capecitabine combination therapy. After four months of administration, abdominal CT revealed liver metastases were remarkably reduced in size. The efficacy of chemotherapy lasted for eight months.     

A case of recurrent breast cancer with multiple liver metastases responding to combination therapy of capecitabine and MPA

The patient was a 68-year-old woman who underwent left partial mastectomy on February 1999. The stage was T2N1. There were positive for estrogen and progesterone receptors in the tumor. After operation, adjuvant therapy consisting of oral administration of tamoxifen and radiation was performed. On February 2005, she felt dyspnea and right femoral pain. After examinations, she was diagnosed as recurrent breast cancer with pleuritis carcinomatosa and bone metastasis. The patient was treated with oral administration of anastrozole and pamidronate disodium 90 mg intravenously every 4 weeks, radiation of her right femur, and OK-432 injection into the intrapleural cavity. On November 2005, she felt general fatigue and anorexia. CT examination revealed multiple liver metastases. She was treated with oral combination chemoendocrine therapy with capecitabine (2,400 mg/day) and MPA (600 mg/day). After the four courses, multiple liver metastases were remarkably reduced in the CT findings. After twelve courses, the partial response continued. No adverse reactions occurred except for gain in weight of grade 1. It is suggested that this oral combination chemoendocrine therapy may be useful for recurrent breast cancer with consideration for treatment effectiveness and the quality of life of the patient.     

Marked efficacy of S-1 against hepatic metastasis of multiple drug-resistant breast cancer--a report of 2 cases

S-1 was found to be highly effective against metastatic hepatic lesions from multiple drug-resistant breast cancers, in 2 patients. The details of these cases are presented below. Case 1, a 59-year-old woman, was HER2-positive. For chemotherapy following a recurrence, trastuzumab+weekly paclitaxel and trastuzumab+vinorelbine regimens were attempted, but the hepatic metastasis worsened. On the other hand, a trastuzumab+S-1 regimen resulted in a notable reduction in the metastatic foci of the liver approximately one month after the initiation of the therapy. This effect was sustained for 5 months thereafter. Case 2 involved a 67-year-old woman with HER2-negative breast cancer. Following a recurrence, chemotherapeutic agents, such as taxane and vinorelbine, were applied, which all resulted in PD. Treatment with S-1 alone reduced the size of the hepatic metastatic lesion, as seen in case 1. Currently(14 months after the initial treatment with S-1), therapeutic efficacy has been maintained. Adverse effects were minimal and QOL was not compromised in either case. We speculate that S-1 is not only effective as a therapeutic agent but is also useful in view of safety and QOL.     

Two cases of recurrent breast cancer with regional lymph node metastases showing a complete response to trastuzumab and paclitaxel treatment

We report two cases of recurrent breast cancer with regional lymph node metastases that responded completely to treatment with trastuzumab and paclitaxel. Case 1: A 52-year-old woman, who presented with left breast cancer, underwent mastectomy and axillary lymph node dissection in July 2002. Pathological findings were as follows: invasive ductal carcinoma (scirrhous type), 2.2 cm in size, histological grade 3, positive invasion to the lymphatic and blood vessels, negative nodal status (0/11), negative ER/PgR status, and overexpression of HER 2/neu. Left axillary lymph node metastasis was noted after five months, ie, in December 2002. Four cycles of chemotherapy with doxorubicin and cyclophosphamide were administered from January 2003; however, they were not effective. The patient showed a complete response after three months of chemotherapy with trastuzumab and paclitaxel. This treatment was stopped in September 2003. She has maintained a complete response for two and a half years and was not administered any further treatment as of February 2006. Case 2: A 59-year-old woman, who presented with right breast cancer, underwent mastectomy and axillary lymph node dissection in May 2002. Pathological findings were as follows: invasive ductal carcinoma (scirrhous type), 1.8 cm in size, histological grade 2, positive invasion to the lymphatic and blood vessels, negative nodal status (0/5), positive ER and uncertain PgR status, and overexpression of HER 2/neu. She had received adjuvant hormonal therapy with tamoxifen; however, a right supraclavicular lymph node metastasis was noted in October 2004. Treatment with exemestane was not effective. However, a complete response was observed with trastuzumab and paclitaxel for four months. She has maintained a complete response for six months and was not administered any further treatment as of February 2006.     

A case of laparoscopic radiofrequency ablation for liver metastatic tumor from colorectal carcinoma

Hepatic resection is a first choice for resectable liver metastatic tumor from colorectal carcinoma. In the case of unresectable tumor or a refusal to operation, laparoscopic radiofrequency ablation (RFA) becomes an option to treat. We report a case of laparoscopic RFA for liver metastatic tumor from colorectal carcinoma. A 74-year-old woman had a laparoscopic transverse colectomy for transverse colon cancer with multiple liver metastases in February 2009. She received UFT/LV and liver metastases were reduced. After the second course, the patient desired to stop chemotherapy. But the liver metastases had grown again. We recommended a hepatic resection. Since she didn't want to have the operation, we performed RFA. After the RFA, a liver metastasis was detected twice. After tumors were located near other organs, we performed a laparoscopic RFA. At 9 months after undergoing last RFA, she had no recurrence in the liver. We thought laparoscopic RFA was safe and effective for the lesion, which was difficult to treat with percutaneous approach RFA.     

Brain metastases after achieving local pathological complete responses with neoadjuvant chemotherapy

Background  We encountered two patients with inflammatory breast carcinoma who developed symptomatic brain metastases after achieving local pathological complete responses (pCR) with neoadju-vant chemotherapy (NAC). Case presentations  The first patient is a 39-year-old woman (Case 1), who underwent NAC with AC (doxorubicin + cyclophosphamide) followed by weekly paclitaxel. After achieving a clinical CR (cCR), we conducted a modified radical mastectomy. Pathological evaluation confirmed no residual malignant cells within the breast tissue or lymph nodes. However, she developed neurological symptoms from brain metastases one month postoperatively. The second patient is a 44-year-old woman (Case 2). Again, no residual malignant cells were detected within the breast tissue or lymph nodes following NAC, but the patient developed symptomatic brain metastases eight months postoperatively. When primary breast tumors are locally advanced, it may be worthwhile to rule out brain metastases even if pCR is obtained after NAC.     

Successful treatment of leptomeningeal metastases from breast cancer using the combination of trastuzumab and capecitabine: a case report

We report a case of metastatic breast cancer with leptomeninges and multiple bone metastases that showed an excellent response to the combination of trastuzumab and capecitabine; therapeutic effect was evaluated by MRI at follow-up. A 44-year-old woman underwent modified radical mastectomy in February 1997. In April 2003, a tumor at the right basis cerebri and multiple bone metastases were noted, and in October 2003, she underwent enucleation of the tumor. Histopathologically, the tumor was consistent with a basal skull metastasis from breast cancer. In March 2004, the patient began to experience pain, weakness, and paresthesia of both legs. She was diagnosed, with leptomeningeal metastasis (LM) from breast cancer using MRI. In December 2005, the combination of trastuzumab and capecitabine administered as sixth-line treatment was very effective for LM. Although it is generally very difficult to diagnose LM and assess the therapeutic effect with MRI, in this case, it was possible. To our knowledge, there has been no report in the literature describing the combination of trastuzumab and capecitabine for LM from breast cancer. Although the mechanism underlying the efficacy of this combination is still unknown, the treatment would be worth trying because of its few side effects in extensively treated patients with LM from breast cancer. To confirm the antitumor efficacy of trastuzumab and capecitabine, however, further investigations are required.     

A case of advanced breast cancer with meningeal carcinomas and orbital metastasis successfully treated with multi-disciplinary therapy

We report a case of advanced breast cancer with meningeal metastasis and orbital metastasis (T4bN3cM1, Stage IV) achieving a significant improvement in QOL by multi-disciplinary therapy. The patient was a 51-year-old woman who had headaches and an ulcerative breast lump with meningeal metastasis and orbital metastasis. A core needle biopsy for breast tumor led to a diagnosis of an invasive ductal carcinoma positive for HER2/neu protein expression. She received 9 cycles of weekly trastuzumab and radiation therapy for meningeal metastasis and orbital metastasis. Although the size of breast tumor, orbital metastasis lesion, and meningeal metastasis lesion exhibited no change, clinical symptoms were improved. One year later, she received paclitaxel so that the sensitivity of HER2/neu dropped. However, the tumor markers relapsed and we then changed paclitaxel to TS-1. Eighteen-months later, she had no neurological symptoms. Multi disciplinary therapy can improve patient's QOL and the clinical outcomes in Stage IV advanced breast cancer.     

Brain metastases after achieving local pathological complete responses with neoadjuvant chemotherapy.

BACKGROUND: We encountered two patients with inflammatory breast carcinoma who developed symptomatic brain metastases after achieving local pathological complete responses (pCR) with neoadjuvant chemotherapy (NAC). CASE PRESENTATIONS: The first patient is a 39-year-old woman (Case 1), who underwent NAC with AC (doxorubicin + cyclophosphamide)followed by weekly paclitaxel. After achieving a clinical CR (cCR), we conducted a modified radical mastectomy. Pathological evaluation confirmed no residual malignant cells within the breast tissue or lymph nodes. However, she developed neurological symptoms from brain metastases one month postoperatively. The second patient is a 44-year-old woman (Case 2). Again, no residual malignant cells were detected within the breast tissue or lymph nodes following NAC, but the patient developed symptomatic brain metastases eight months postoperatively. When primary breast tumors are locally advanced, it may be worthwhile to rule out brain metastases even if pCR is obtained after NAC.     

Two bedridden patients with bone metastases from breast cancer effectively treated with pamidronate therapy

Case 1: A 43-year-old woman underwent mastectomy because of locally advanced breast cancer with multiple bone metastases. She was treated with CMF therapy but developed a compression fracture of a thoracic vertebra after 10 months and received pamidronate therapy. Pamidronate administration relived her back pain after 2 months and she was able to walk again after 3 months. However, she developed a resistance to the treatment, and then refused another treatment. She was found to have hypercalcemia 6 months later and received pamidronate again, but died 9 months after the treatment. Case 2: A 52-year-old woman underwent mastectomy because of breast cancer (T2) and was diagnosed as having multiple bone metastases 24 months after the operation. She could not turn over in bed due to progressing bone pain and received pamidronate therapy with CMF therapy at home 23 months after the diagnosis. After 2 months, pamidronate administration relieved her bone pain and she was free of pain after 4 months. After 5 months, X-rays revealed that lytic lesions showed sclerosis, and the pamidronate therapy was assessed as producing a PR. Pamidronate therapy improved her quality of life and activities of daily living, and she continues to receive it this time as an outpatient. Pamidronate therapy is promising as an effective treatment for bedridden patients with bone metastasis from breast cancer.     

A case report of both CAF and docetaxel-resistant breast cancer responding to paclitaxel weekly therapy

A 58-year-old woman underwent CAF and docetaxel therapy for lung, liver and bone metastases from breast cancer operated on 14 years ago. Because of progressive disease due to secondary resistance to CAF and docetaxel, the patient was given three courses of paclitaxel therapy (60 mg/m2, day 1, 8, 15, repeated every 4 weeks). The paclitaxel weekly therapy brought about no adverse effects and remarkable effects against lung and liver metastases (PR). Although the duration of the response to the paclitaxel therapy was limited to about two months due to the progression of skull bone metastasis, paclitaxel weekly therapy may be effective against both CAF and docetaxel-resistant breast cancer.